This review discusses the surgical treatment of infective endocarditis (IE), emphasizing the increasing role of surgery in managing this severe cardiac condition. The review highlights the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite global data variability, over 50% of IE patients undergo surgery in tertiary centers. Preoperative considerations include accurate diagnosis, appropriate antimicrobial treatment, and timely surgery, especially for patients with heart failure or embolism risk. Surgical approaches vary based on valve involvement, with mitral valve repair showing better outcomes than replacement. Aortic valve surgery, traditionally favoring replacement, now includes repair as an option. Emerging techniques like sutureless valves and aortic homografts are explored for their potential benefits in specific cases. High-risk groups, such as intravenous drug users and the elderly, require tailored surgical strategies. The review also addresses the rising prevalence of prosthetic valve endocarditis and device-related IE, emphasizing the need for comprehensive management. The review underscores the importance of a multidisciplinary approach and ongoing research to optimize patient outcomes. It highlights the benefits of early surgery, particularly in heart failure and embolism risk, and discusses the challenges and controversies in surgical techniques for different valve involvement scenarios. The review also explores the use of homografts, stentless xenografts, and the Commando procedure in complex cases. It concludes that surgery remains a critical treatment option for IE, with ongoing research and tailored approaches essential for improving patient outcomes.This review discusses the surgical treatment of infective endocarditis (IE), emphasizing the increasing role of surgery in managing this severe cardiac condition. The review highlights the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite global data variability, over 50% of IE patients undergo surgery in tertiary centers. Preoperative considerations include accurate diagnosis, appropriate antimicrobial treatment, and timely surgery, especially for patients with heart failure or embolism risk. Surgical approaches vary based on valve involvement, with mitral valve repair showing better outcomes than replacement. Aortic valve surgery, traditionally favoring replacement, now includes repair as an option. Emerging techniques like sutureless valves and aortic homografts are explored for their potential benefits in specific cases. High-risk groups, such as intravenous drug users and the elderly, require tailored surgical strategies. The review also addresses the rising prevalence of prosthetic valve endocarditis and device-related IE, emphasizing the need for comprehensive management. The review underscores the importance of a multidisciplinary approach and ongoing research to optimize patient outcomes. It highlights the benefits of early surgery, particularly in heart failure and embolism risk, and discusses the challenges and controversies in surgical techniques for different valve involvement scenarios. The review also explores the use of homografts, stentless xenografts, and the Commando procedure in complex cases. It concludes that surgery remains a critical treatment option for IE, with ongoing research and tailored approaches essential for improving patient outcomes.